Ruth to the Rescue: Health insurance mix-up

Health insurance lesson from one customer's mix-up

Like millions of Americans, Tom Stellini has been learning tough lessons about America's new health care system under the Affordable Care Act.

"The policy that I had for several years was being canceled because of the Affordable Care Act," Stellini told Ruth to the Rescue.

Stellini contacted Blue Cross Blue Shield and purchased a new policy through the insurance marketplace.

"So we crossed the t's, dotted the i's and I gave him my January premium," said Stellini.

Soon after he paid the $381 premium in January, Stellini's employer offered him health care coverage that was a better deal. He decided to cancel the policy he had purchased through the marketplace.

"I immediately called Blue Cross to cancel the policy, and they said go to the marketplace," he said. "I called the Marketplace and she told me, 'well we can't cancel it.' I said 'What do you mean you can't cancel it?' and she didn't know what to do."

That phone call was the beginning of a three-month battle to find a way to cancel his policy.

"So I tried Blue Cross again. They told me go to the marketplace," he said. "I went back and forth and back and forth."

Stellini's policy was finally canceled in March, but another problem was brewing during those three months. He had filed health claims that were applied to his marketplace policy instead of the coverage through his employer.

"My policy through my employer pays 100 percent, the marketplace only paid 80 percent, so I kept getting bills and bills and bills," said Stellini. "The most important thing people can do to change or cancel their coverage is to talk to the marketplace."

By September, Stellini felt he wasn't getting anywhere when it came to getting those claims applied to the correct policy.

Important Lesson About Cancellations

Like Stellini, many people may have thought once they bought a policy, the insurance company made the necessary changes. That's not how it works.

Ruth to the Rescue went to Blue Cross Blue Shield on Stellini's behalf. Although privacy policies prevent the company from discussing details of his case, it
did confirm federal regulations require all marketplace-insurance cancellations or changes must go through the marketplace.

"The most important thing people can do to change or cancel their coverage is to talk to the marketplace. And they will determine at what point that coverage ends, and then tell the insurer to change that coverage as of that date," said Kirk Roy, vice president of Health Care Reform at Blue Cross Blue Shield.

So why the mix-up and delays getting the claims adjusted?

"The marketplace undertaking was huge last year," Roy explained. "So it was not uncommon for us to see lags, changes, discrepancies that we all had to work through, and we were trying to make it work."

Once Ruth to the Rescue got involved, Stellini said he saw the process speed up quickly and almost all of his claims were fixed.

"I really appreciate Ruth to the Rescue coming to the rescue," Stellini said. "Their phone call did the trick."

"I would say we all had challenges, given the volume of change and the amount of adjustments we had to do," said Roy. "We're always trying to make that better and more timely."

Marketplace Questions Linger

As for the marketplace, a spokesperson told Ruth to the Rescue, "Our casework team is actively researching what may have happened in this case and is working to see what may be done to help the consumer."

Stellini says he is still trying to confirm that his cancellation date was in January and not March. He's worried he'll still be billed for the two extra months, and wondering if he'll be liable for any subsidies the government was paying for those months, even though he had been trying repeatedly to cancel the policy.

Stellini tells Ruth to the Rescue an appeals hearing (via phone) is pending with the marketplace. Our consumer unit will be following the process until there's a final decision.

For their part, a spokesperson for the marketplace say they'll keep learning, listening, and making improvements to the system. We'll see how things go this year, when the Open Enrollment period kicks off on Saturday, November 15th.

Entire Marketplace Statement

Consumers have the ability to cancel their Marketplace plan at any time and may do so by logging into their Marketplace account and selecting the "Terminate/end all coverage" button. Life changes can be reported to the Marketplace online or by contacting the Marketplace Call Center at 1-800-318-2596.

Our casework team is actively researching what may have happened in this case and is working to see what may be done to help the consumer. Should individuals have questions about their coverage or are interested in their health care options for 2015, they are encouraged to visit healthcare.gov or call the Marketplace Call Center at 1-800-318-2596.